Application of a new histological staging and grading system for primary biliary cirrhosis to liver biopsy specimens: Interobserver agreement
Article first published online: 26 JAN 2010
© 2010 The Authors. Journal compilation © 2010 Japanese Society of Pathology
Volume 60, Issue 3, pages 167–174, March 2010
How to Cite
Nakanuma, Y., Zen, Y., Harada, K., Sasaki, M., Nonomura, A., Uehara, T., Sano, K., Kondo, F., Fukusato, T., Tsuneyama, K., Ito, M., Wakasa, K., Nomoto, M., Minato, H., Haga, H., Kage, M., Yano, H., Haratake, J., Aishima, S., Masuda, T., Aoyama, H., Miyakawa-Hayashino, A., Matsumoto, T., Sanefuji, H., Ojima, H., Chen, T.-C., Yu, E., Kim, J.-H., Park, Y. N. and Tsui, W. (2010), Application of a new histological staging and grading system for primary biliary cirrhosis to liver biopsy specimens: Interobserver agreement. Pathology International, 60: 167–174. doi: 10.1111/j.1440-1827.2009.02500.x
- Issue published online: 23 FEB 2010
- Article first published online: 26 JAN 2010
- Received 23 February 2009. Accepted for publication 28 October 2009.
- primary biliary cirrhosis;
- staging and grading
Recently the authors proposed a new staging and grading system for primary biliary cirrhosis (PBC) that takes into account necroinflammatory activity and histological heterogeneity. Herein is proposed a convenient version of this system. Scores for fibrosis, bile duct loss, and chronic cholestasis were combined for staging: stage 1, total score of 0; stage 2, score 1–3; stage 3, score 4–6; and stage 4, score 7–9. Cholangitis activity (CA) and hepatitis activity (HA) were graded as CA0–3, and HA0–3, respectively. Analysis of interobserver agreement was then conducted. Digital images of 62 needle liver biopsy specimens of PBC were recorded as virtual slides on DVDs that were sent to 28 pathologists, including five located overseas. All participants were able to apply this version in all 62 cases. For staging, kappa was 0.385 (fair agreement) and the concordance rate was 63.9%. For necroinflammatory activity, the kappa and concordance rate were 0.110 (slight agreement) and 36.9% for CA, and 0.197 (slight agreement) and 47% for HA, respectively. In conclusion, this new staging and grading system for PBC seems to be more convenient and practical than those used at present, but more instruction and guidance are recommended for the grading of necroinflammatory activity in practice.